RESEARCH ARTICLE


Knowledge and Awareness of School Teachers Regarding Emergency Management of Tooth Avulsion in the Kingdom of Saudi Arabia: A Cross-Sectional Study



Basim Almulhim1, *
1 Department of Preventive Dental Sciences, College of Dentistry, Majmaah University, Al-Majmaah, 11952, Saudi Arabia


Article Metrics

CrossRef Citations:
0
Total Statistics:

Full-Text HTML Views: 652
Abstract HTML Views: 177
PDF Downloads: 97
ePub Downloads: 61
Total Views/Downloads: 987
Unique Statistics:

Full-Text HTML Views: 321
Abstract HTML Views: 97
PDF Downloads: 66
ePub Downloads: 35
Total Views/Downloads: 519



Creative Commons License
© 2022 Basim Almulhim

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Preventive Dental Sciences, College of dentistry, Majmaah University, Al-Majmaah, 11952, Saudi Arabia; Tel: +966-500222665, E-mail: b.almulhim@mu.edu.sa


Abstract

Aim:

This study aimed to assess the general knowledge and awareness of school teachers regarding the first aid emergency dental management of tooth avulsion in the kingdom of Saudi Arabia.

Materials and Methods:

A self-administered, anonymous, close-ended structured questionnaire was given to school teachers in Saudi Arabia. It included information regarding gender, knowledge, and awareness [three parts: basic demographic characteristics focusing on the gender (part one), questions regarding knowledge of school teachers toward emergency management of tooth avulsion (part two), and questions regarding awareness of school teachers toward emergency management of tooth avulsion (part three)].

Results:

A total of 615 school teachers (58% males and 42% females) completed the questionnaire. Approximately 54.3% of the school teachers preferred to immediately refer the child to the dentist if trauma affects permanent teeth (p < 0.05), and only 2.1% opined regarding reposition of the tooth in a normal position. Another 22.9% responded that they would scrub the tooth to clean the dirt and rinse with water, while 19.7% reported that they would keep the tooth in a wet handkerchief until they reach the dentist.

Conclusion:

The knowledge and awareness of schoolteachers regarding the management of avulsed teeth are insufficient; thus, education programs on traumatic dental injuries are essential.

Keywords: Dental trauma, Avulsion, Teachers, Children, Storage media, Dental management.



1. INTRODUCTION

Traumatic dental injury in preschool and school children is most common, which is related to immature motor control, unguarded play, and hyperactivity [1, 2]. The luxation injury most commonly occurs in primary teeth due to soft, pliable young alveolar bone and affects the surrounding structures, such as soft tissue, between ages one to three years [3-5]. A previous study reported that 22% of children sustain injuries to permanent dentition and 30% to primary dentition [6]. It is estimated that over 50% of children are exposed to traumatic dental injuries before leaving school [7]. The crown fracture more commonly occurs in permanent dentition, and an estimated 26–76% of injuries have been reported for the permanent dentition [8]. Luxation injuries are estimated to occur from 30 – 44% of all dental injuries [2]. An avulsion is a traumatic dental injury where a tooth dislodges entirely out of the socket. It is the most severe and complicated dental injury, seen to vary in range from 0.5 to 3.5% of all traumatic dental injuries, with the peak incidence between 7- to 11-years and the maxillary central incisors being the most affected [2, 5, 9]. Immediate replantation of the avulsed tooth is the best treatment of choice, with 85–97% success rates [10]. The management of dental avulsion depends on many factors, such as maturity of the tooth root end (close or open root apex) and health status of the periodontal dental ligament (based on the extra-oral time and type of storage media) [2, 9]. There are contraindications of replanting the avulsed tooth in some situations, such as severe carious tooth, severe periodontal disease, extremely uncooperative child, and medical conditions (e.g., cardiac patient and immunosuppressed patient) [9]. The possibility of replantation largely depends on critical extra-oral time [11].

The prevalence of traumatic dental injuries in Saudi Arabia was reported as 39.5% among school children aged 7-9 years [12]. Tooth fracture (22.7%) was the commonly reported dental trauma in this study, followed by tooth displacement due to trauma (8.7%) and complete tooth loss (8%) [12]. Another study from Saudi Arabia reported that 33% of the study subjects experienced dental trauma among school children aged 5-6 years [13]. The authors concluded that enamel fracture (71%) was the most frequent type of dental trauma, followed by tooth loss (13%) [13]. A recent study from Saudi Arabia has reported dental trauma in 49% of the participants, and the common reasons for dental trauma were falls (21.7%) and fights (22.8%) [14].

Dental trauma can occur in growing children since their permanent teeth erupt during this period. At least 50% of children might experience dentoalveolar trauma during their school time. Additionally, children tend to have an increased likelihood of dental trauma due to recreational activities and sporting events [1, 2]. Therefore, assessing school teachers' knowledge and awareness concerning dental injuries and treatment approaches may play a vital role in the management of dental trauma. Prior studies have shown a lack of school teachers' knowledge regarding dental trauma's emergency management [7, 15-18]. The parents and school teachers should be familiar with first aid management of dental trauma. Sufficient knowledge with good practice management is required to achieve an effective final result. In the Arabian region, no recent study has reported on the knowledge and awareness of dental trauma among school teachers. Hence, the present study aimed to assess general knowledge and awareness of school teachers regarding the first aid dental emergency management of avulsion tooth.

2. MATERIALS AND METHODS

Ethical approval was obtained from the Ethical Committee of the Deanship of Scientific Research, Majmaah University under MUREC-Apr.29/COM-2020/28-2. An electronic questionnaire was distributed among primary school teachers to assess their knowledge and awareness regarding emergency management of avulsion teeth in school children. The questionnaire was distributed into three different parts. The first part involved basic demographic characteristics, with a focus on gender. The second part included questions on the knowledge of school teachers toward emergency management of tooth avulsion. The third part of the questionnaire involved questions regarding awareness of school teachers toward emergency management of tooth avulsion. The data were collected in the Arabic language (the teachers’ original language) through a self-administered electronic questionnaire that has been converted into the Arabic language from English. For determining the validity of the questionnaire, all the parts of the questionnaire were reviewed by an expert in the field of pediatric dentistry in order to determine that the questionnaire was comprehensive enough to cover all the data required to address the study's objectives. Prior consent was obtained from the participants of the survey before they responded to this questionnaire. The questionnaire was distributed randomly to the school teachers in Saudi Arabia. The questionnaire was divided into sections of knowledge (Q2, 5, 6, 7, 9, and 10) and awareness (Q3, 4, 8, 11, 12, 13, 14, and 15) for the analysis. The responses of participants to questions of knowledge and awareness were compared based on gender.

2.1. Statistical Analysis

Responses were collected and tabulated in an excel sheet, which was converted into an SPSS data sheet. Descriptive statistical analysis was carried out using the SPSS software (version 17.0, Chicago, Illinois, USA), and a chi-square test was utilized for comparison at a 95% confidence interval with a p-value less than 0.05.

3. RESULTS

A total of 615 (58% males and 42% females) school teachers responded to the questionnaire. More than half of the school teachers (59.3%) reported supervising the children during sports activities (p< 0.05), and 5.7% witnessed dental trauma during their supervision (Table 1). Most of the participants (72.5%) were not aware of differentiating between primary and permanent teeth. The responses to knowledge questions and awareness questions are summarized in (Tables 2 and 3), respectively. The majority of participants did not know regarding the immediate management of avulsed primary tooth (44.4%), and only 10.2% had good knowledge. About 54.3% of the school teachers preferred to immediately refer the child to the dentist if trauma affects the permanent tooth (p< 0.05), and only 2.1% opined repositioning the tooth in a normal position. 47% of the school teachers responded that they would reimplant the tooth within 30 minutes, while 38% of the participants answered that they would reposition the tooth immediately. Another 22.9% of teachers responded that they would scrub the tooth to clean the dirt and rinse with water, and 19.7% of teachers reported that they would keep the tooth in a wet handkerchief until they reach the dentist (Fig. 1). The majority of the participants did not know how to grab the avulsed tooth (from tooth crown or root), i.e., 48% (p< 0.05) (Table 2).

A significant difference was observed among school teachers regarding the knowledge of managing an avulsed tooth. The majority of school teachers did not have sufficient knowledge of dental trauma (86.3%). Approximately 77.9% have not received any prior advice on managing the avulsion of the tooth, while the other 22.1% received information from the internet (p < 0.05). Nearly 90% postulated the importance of the educational program and showed their interest in attending workshops and courses on how to deal with and manage dental trauma (p < 0.05).

Table 1. Overall responses of school teachers regarding emergency management of avulsed tooth.
Question Response Percentage
Q1 Gender Female 42.0%
Male 58.0%
Q2 Can you differentiate between baby teeth and permanent teeth? No 72.5%
Yes 27.5%
Q3 Do you supervise the children during sport activities? No 40.7%
Yes 59.3%
Q4 Have you come across an accident where a tooth was avulsed? No 94.3%
Yes 5.7%
Q5 What is the immediate management of avulsion teeth if that baby tooth? Don’t know 44.4%
Put back the tooth into original position 1.1%
Refer the child immediately to the dentist 32.0%
Throw-out. 10.2%
Wash the child's mouth with tap water and take the tooth in a wet cloth 12.2%
Q6 What is the immediate management of avulsion teeth if that permanent tooth? Don’t know 32.0%
Put back the tooth into original position 2.1%
Refer the child immediately to the dentist 54.3%
Throw-out. 1.8%
Wash the child's mouth with tap water and take the tooth in a wet cloth 9.8%
Q7 How urgently do you think it is to seek a dentist help, if a permanent tooth has been avulsion? Before next day 14.8%
Immediate 38.0%
Others .2%
Within 30 min 47.0%
Q8 What would you do if the avulsion tooth was covered with dirt? Scrub the tooth to remove the dirt rinse with tap water 22.9%
Wash with hydrogen peroxide 13.2%
Wash with sterile saline 28.6%
Wipe the tooth with tissue paper 17.4%
Would do nothing 17.9%
Q9 How would you keep the tooth till you reach the dentist? Don’t know .3%
Others please state .8%
Put it in Any antiseptic solution 7.0%
Put it in Child's mouth 7.8%
Put it in Cold Milk 11.9%
Put it in Cotton pad 11.1%
Put it in HBSS 16.4%
Put it in Ice Tap water 8.8%
Put it in Sterile saline 16.3%
Put it in Wet handkerchief 19.7%
Q10 How would you hold the tooth? Anywhere (crown or root) 48.0%
From the Crown 35.3%
From the root 16.7%
Q11 Have you received advice on what to do when a permanent tooth was avulsion in an accident? No 77.9%
Yes 22.1%
Q12 If yes. The source of your information? Dental clinic/ Dental hospital 5.7%
Governmental program .2%
Others, Internet, etc, 15.4%
Teachers training 1.3%
Q13 Are you satisfied with your knowledge on 'the management of dental Trauma'? No 86.3%
Yes 13.7%
Q14 Do you think it is important to have an educational program in 'management of dental trauma? No 11.1%
Yes 88.9%
Q15 Would you like to attend an educational program on 'management of dental trauma'? No 12.8%
Yes 87.2%
Table 2. Gender-based comparison of responses related to knowledge among school teachers regarding emergency management of avulsed tooth.
  Response Female Male P Value
K1 Q2: Can you differentiate between baby teeth and permanent teeth?
No 69% 75% 0.09
Yes 31% 25%
K2 Q5: What is the immediate management of avulsion teeth if that baby tooth?
Don’t know 40% 47% 0.03
Put back the tooth into original position 2% 1%
Refer the child immediately to the dentist 38% 28%
Throw-out. 10% 10%
Wash the child's mouth with tap water and take the tooth in a wet cloth 10% 14%
K3 Q6: What is the immediate management of avulsion teeth if that permanent tooth?
Don’t know 34% 31% 0.00
Put back the tooth into original position 4% 1%
Refer the child immediately to the dentist 55% 54%
Throw-out. 0% 3%
Wash the child's mouth with tap water and take the tooth in a wet cloth 6% 13%
K4 Q7: How urgently do you think it is to seek a dentist help, if a permanent tooth has been avulsion?
Before next day 17% 13% 0.66
Immediately 33% 42%
Others 0% 0.3%
Within 30 mins 49% 45%
K5 Q9: How would you keep the tooth till you reach the dentist?
Don’t know 1% 0% 0.00
Others please state 0% 1%
Put it in Any antiseptic solution 11% 5%
Put it in Child's mouth 14% 4%
Put it in Cold Milk 8% 15%
Put it in Cotton pad 17% 7%
Put it in HBSS 9% 22%
Put it in Ice Tap water 11% 7%
Put it in Sterile saline 15% 17%
Put it in Wet handkerchief 16% 23%
K6 Q10: How would you hold the tooth?
Anywhere (crown or root) 40% 54% 0.00
From the Crown 33% 37%
From the root 28% 9%
Table 3. Gender-based comparison of responses related to awareness among school teachers regarding emergency management of avulsed tooth.
  Response Female Male P Value
A1 Q3: Do you supervise the children during sport activities?
No 66% 22% 0
Yes 34% 78%
A2 Q4: Have you come across an accident where a tooth was avulsed?
No 95% 94% 0.81
Yes 5% 6%
A4 Q8: What would you do if the avulsion tooth was covered with dirt?
Scrub the tooth to remove the dirt rinse with tap water 16% 28% 0
Wash with hydrogen peroxide 16% 11%
Wash with sterile saline 27% 30%
Wipe the tooth with tissue paper 15% 19%
Would do nothing 25% 13%
A5 Q11: Have you received advice on what to do when a permanent tooth was avulsion in an accident?
No 78% 78% 0.852
Yes 23% 22%
A6 Q13: Are you satisfied with your knowledge on 'the management of dental trauma?
No 81% 90% 0.002
Yes 19% 10%
A7 Q14: Do you think it is important to have an educational program in management of dental trauma?
No 18% 6% 0
Yes 82% 94%
A8 Q15: Would you like to attend an educational program on 'management of dental trauma?
No 21% 7% 0
Yes 79% 93%
Fig. (1). Preference of school teachers regarding transport medium in emergency management of avulsed tooth.

4. DISCUSSION

Dental trauma is a sudden incident and requires prompt action with appropriate knowledge on first aid management. School teachers need to be informed regarding dental trauma and its management; however, most teachers have not received any relevant prior information regarding how to proceed with it [7, 19]. The main treatment objective of replanting an avulsed tooth is to maintain the patient's esthetics and function and reduce the psychological trauma of missing teeth. Another problem, in addition to the above, is unintentional root resorption, and its prevention is the prime concern for treating dentists [20]. Timely intervention with the use of appropriate transport media reduces the risk of root resorption. Only 2.1% of our respondents expressed that they would retain the avulsed tooth immediately to normal position. Similar results have been reported in the prior studies published from various countries [7, 21, 22].

Numerous storage media can be used, such as HBSS, cold milk, normal saliva, normal saline solution, and regular water, to preserve the avulsed tooth. Although regular water is most commonly accessible, it should be considered the last storge media as it affects the periodontal ligament and causes lysis of healthy cells on the periodontal ligament [23]. The majority of the teachers who participated in the present study were not aware of the exact storage media favorable for an avulsed tooth. In the present study, the most favored medium for storing an avulsed tooth was ‘Put it in Wet handkerchief’ (19.7%), followed by ‘Put it in HBSS’ (16.4%).

Shamarao et al. [24] reported that 9.3% of school teachers chose milk as a storage medium, comparable to the present study, where 11.9% chose cold milk. According to our study, 77.9% of the teachers have not received any prior advice or education on dental emergencies. This finding has been found to be consistent with previously published studies [15, 21, 25-27]. The dental emergency education program should be a part of the annual educational course in the schools. It should include appropriate information on how to handle the child and the tooth during sports activities. Overall results showed that Saudi teachers lack knowledge and awareness regarding managing traumatic dental injuries.

Approximately 19.7% of the school teachers reported consulting a nearby dental hospital after dental trauma or immediately referring to a dentist [28]. In our study, only 32% of teachers picked the option of referring to dentists after primary tooth avulsion, while 54.3% were willing to refer after permanent tooth trauma. This difference might be due to the notion that baby teeth may eventually fall, and permanent teeth will occupy their position. On the other hand, among primary school teachers, most teachers did not receive any training on the emergency management of dental trauma (77.9%); thus, we recommend that medical care (first aid) and dental trauma management should be mandatory for all school teachers in Saudi Arabia.

In an Iranian study, 60% of schoolteachers reported responding to dental trauma in school themselves. About 70% reported that being educated in emergency management of dental trauma might improve traumatized teeth's prognosis. Only 7.5% of teachers responded retaining the avulsed tooth to normal position by themselves [29]. Surprisingly, only 2.1% of our respondents stated that they would re-implant the avulsed tooth. More than 94.7% of participants thought that their knowledge was insufficient and they were interested in learning more. In the present study, over 87.2% of the school teachers felt that they needed further education on avulsed teeth's emergency management.

Pithon et al. [30] studied knowledge levels in Brazilian schoolteachers and found that approximately half of the teachers surveyed (48.2%) had insufficient knowledge. Only 38.3% of school teachers had received training on emergency management of dental trauma, and only 17% correctly reported milk, the oral cavity, or filtered water as an adequate storge media for preserving the avulsed tooth while reaching to the dentist. Singh et al. [31] stressed the importance of intimation of the traumatic event to parents. The authors noticed that 43% of the school teachers preferred to contact the parents immediately to take the child to a dentist [31]. In our study, the majority of the participants (54.3%) chose to refer and consult with the dentist. The extra-oral dry time is crucial for replantation, and 30 min time is considered more significant [11]; in our study, most of the school teachers (47%) preferred to visit dental clinic within 30 mins, and 38% preferred immediate consultation. Even though there is a lack of knowledge regarding emergency management of avulsed tooth, the school teachers in the present study were aware of referring the child to the dentist as early as possible.

The majority of school teachers (87.2%) showed their willingness to attend education programs on emergency management of avulsed teeth. In the present study, we found insufficient knowledge among the school teachers regarding the management of avulsed teeth. The author opines that dental trauma in the schools may be minor due to the lack of knowledge on emergency management of avulsed tooth or traumatic dental injuries. However, it is essential to provide sufficient knowledge to schoolteachers on storage media, handling the avulsed tooth, replacing the tooth, and especially, on the difference between primary and permanent teeth.

CONCLUSION

The knowledge and awareness among schoolteachers regarding the management of avulsed teeth are insufficient; therefore, education programs on traumatic dental injuries management are essential. About 86.3% of the participants were found unsatisfied with their knowledge on the emergency management of avulsed tooth.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

This study received the approval of the Institutional Review Board of Majmaah University under number MUREC-Apr.29/COM-2020/28-2.

HUMAN AND ANIMAL RIGHTS

No animals were used in this research. All human research procedures were followed in accordance with the ethical standards of the committee responsible for human experimentation (institutional and national), and with the Helsinki Declaration of 1975, as revised in 2013.

CONSENT FOR PUBLICATION

All participants in the study agreed to participate by responding to the study questionnaire.

STANDARDS FOR REPORTING

STROBE guidelines and methodologies and methodologies were followed in this study.

AVAILABILITY OF DATA AND MATERIALS

The data that support the findings of this study are available from [B.A], upon reasonable request.

FUNDING

This study was supported by the Deanship of Scientific Research at Majmaah University under project number: R-2021-76.

CONFLICT OF INTEREST

The author declares no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

The author would like to thank all schoolteachers who participated in the study.

The author would like to thank the Deanship of Scientific Research at Majmaah University for supporting this work.

REFERENCES

[1] Caglar E, Ferreira LP, Kargul B. Dental trauma management knowledge among a group of teachers in two south European cities. Dent Traumatol 2005; 21(5): 258-62.
[2] Andreasen JO, Andreasen FM, Andersson L, Andreasen JO. Textbook and color atlas of traumatic injuries to the teeth Classification, epidemiology and etiology 5th ed. 2019; 252-82.
[3] Malmgren B, Andreasen JO, Flores MT, et al. Guidelines for the management of traumatic dental injuries:3 Injuries in the primary dentition. Pediatr Dent 2017; 39(6): 420-8.
[4] Diangelis AJ, Andreasen JO, Ebeleseder KA, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dent Traumatol 2012; 28(1): 2-12.
[5] Glendor U, Halling A, Andersson L, Eilert-Petersson E. Incidence of traumatic tooth injuries in children and adolescents in the county of Västmanland, Sweden. Swed Dent J 1996; 20(1-2): 15-28.
[6] Andreasen JO, Ravn JJ. Epidemiology of traumatic dental injuries to primary and permanent teeth in a Danish population sample. Int J Oral Surg 1972; 1(5): 235-9.
[7] Chan AW, Wong TK, Cheung GS. Lay knowledge of physical education teachers about the emergency management of dental trauma in Hong Kong. Dent Traumatol 2001; 17(2): 77-85.
[8] Gassner R, Bösch R, Tuli T, Emshoff R. Prevalence of dental trauma in 6000 patients with facial injuries: Implications for prevention. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 87(1): 27-33.
[9] Andersson L, Andreasen JO, Day P, et al. Guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Pediatr Dent 2017; 39(6): 412-9.
[10] 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(2): 76-89.
[11] Flores MT, Andersson L, Andreasen JO, et al. Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth. Dent Traumatol 2007; 23(3): 130-6.
[12] Al-Ansari A, Nazir M. Prevalence of dental trauma and receipt of its treatment among male school children in the eastern province of saudi arabia. Scientific World Journal 2020; 2020: 7321873.
[13] Al-Majed I, Murray JJ, Maguire A. Prevalence of dental trauma in 5-6- and 12-14-year-old boys in Riyadh, Saudi Arabia. Dent Traumatol 2001; 17(4): 153-8.
[14] Gaffar B, AlHumaid J, Ashraf Nazir M, Alonaizan F. Traumatic dental injuries in the Eastern Region of Saudi Arabia: Factors influencing teachers’ management practices. Dent Traumatol 2021; 37(1): 65-72.
[15] 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(1): 2-5.
[16] Alsadhan SA, Alsayari NF, Abuabat MF. Teachers’ knowledge concerning dental trauma and its management in primary schools in Riyadh, Saudi Arabia. Int Dent J 2018; 68(5): 306-13.
[17] Addo ME, Parekh S, Moles DR, Roberts GJ. Knowledge of dental trauma first aid (DTFA): the example of avulsed incisors in casualty departments and schools in London. Br Dent J 2007; 202(10)E27
[18] Al-Obaida M. Knowledge and management of traumatic dental injuries in a group of Saudi primary schools teachers. Dent Traumatol 2010; 26(4): 338-41.
[19] Hamilton FA, Hill FJ, Holloway PJ. An investigation of dento-alveolar trauma and its treatment in an adolescent population. Part 2: Dentists’ knowledge of management methods and their perceptions of barriers to providing care. Br Dent J 1997; 182(4): 129-33.
[20] Rao A, Tummala M, Kommula A. Delayed replantation after prolonged dry storage. Saudi Endod J 2014; 4(2): 91-4.
[21] Ibrahim Y, H. Abuaffan A. Knowledge and attitude of Sudanese school health teachers regarding first aid management of dental trauma. Dent Oral Craniofac Res 2016; 2(2): 242-6.
[22] 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 Prev Dent 2009; 27(4): 242-8.
[23] Trope M. Avulsion of permanent teeth: Theory to practice. Dent Traumatol 2011; 27(4): 281-94.
[24] Shamarao S, Jain J, Ajagannanavar SL, Haridas R, Tikare S, Kalappa AA. Knowledge and attitude regarding management of tooth avulsion injuries among school teachers in rural India. J Int Soc Prev Community Dent 2014; 4(1)(Suppl. 1): S44-8.
[25] Al-Jundi SH, Al-Waeili H, Khairalah K. Knowledge and attitude of Jordanian school health teachers with regards to emergency management of dental trauma. Dent Traumatol 2005; 21(4): 183-7.
[26] Sarhan Alzahrani M, Almaqboul FA. Parents’ awareness and attitude toward urgent management of avulsed permanent tooth in AL-Baha city. Saudi Endod J 2019; 9(2): 82-7.
[27] Altamimi YS, Siddiqui AA, At-Tamimi S, et al. Knowledge of primary school teachers regarding dental trauma management in hail region, Saudi Arabia. Pesqui Bras Odontopediatria Clin Integr 2019; 19(1): 2-7.
[28] Alluqmani FA, Omar OM. Assessment of schoolteachers’ knowledge about management of traumatic dental injuries in Al-Madinah city, Saudi Arabia. Eur J Dent 2018; 12(2): 171-5.
[29] Attarzadeh H, Kebriaei F, Sadri L, Foroughi E, Taghian M. Knowledge and attitudes of elementary schoolteachers on dental trauma and its management in Yazd, Iran. J Dent (Shiraz) 2017; 18(3): 212-8.
[30] Pithon MM, Lacerda dos Santos R, Magalhães PH, Coqueiro RdaS. Brazilian primary school teachers’ knowledge about immediate management of dental trauma. Dental Press J Orthod 2014; 19(5): 110-5.
[31] Singh M, Ingle NA, Kaur N, Yadav P. Evaluation of knowledge and attitude of school teachers about emergency management of traumatic dental injury. J Int Soc Prev Community Dent 2015; 5(2): 108-3.